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Msk > Bone Problems > Flashcards

Bone Problems Flashcards

0
Q

How does bacteria actually get into the bone?

A

Haematogenous spread

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1
Q

In osteomyelitis where exactly does the infection occur?

A

Bone + marrow

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2
Q

In children how does osteomyelitis occur?

A

Transient bacteraemia – >

seeding of metaphysis - usually at tibia/fibula

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3
Q

In adults how does osteomyelitis occur?

A

Open wound – >bacteraemia – > seed epiphysis

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4
Q

What is the most common site of infection in the bone? And why?

A

Metaphysis

Vascular supply is the best at metaphysis

therefore favours haematogenous spread

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5
Q

What is the most common bacteria cause of osteomyelitis?

A

Staph aureus

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6
Q

Are sexually active adults presents with osteomyelitis. What bacterial infection does he have?

A

Neisseria gonorrhoea

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7
Q

A patient with sickle-cell disease presents with osteomyelitis. What bacterial infection does he have?

A

Salmonella

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8
Q

Diabetic + IV drug user
who happens to wear rubber footwear and has a puncture in his foot

presents with osteomyelitis. What a bacterial infection does he have?

A

Pseudomonas

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9
Q

Patient presents with a cat/dog bite.
What bacterial infection does he have?
Apart from the obvious what else does he have?

A

Osteomyelitis

Cellulitis septic arthritis endocarditis meningitis

COSEM..

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10
Q

A patient with TB presents with osteomyelitis. It has affected his lumbar vertebrae. What does he have? And where does the spread come from?

A

Pots disease

Haematogenous spread from primary lung focus

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11
Q

What are the clinical features of osteomyelitis?

A

Bone pain, fever, leucocytosis,

Warmth, erythema, swelling

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12
Q

On x-ray what do is see for osteomyelitic infection?

A

Lytic focus
(Liquefactive necrosis -Sequestrum Brodies abscess)

surrounded by sclerosis – Involucrum

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13
Q

Treatment for osteomyelitis?

How do you diagnose it?

A

Surgery + antibiotics

Blood culture

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14
Q

Explain how we form that reactive bone that causes sclerosis?

A

Bacteria – > inflammatory exudate @marrow ->

increased intermedullary pressure
+
exudate into bone cortex – >

neutrophils enzymatically destroyed by bone – >

Rupture through periosteum->interrupt periosteal BF

sequestral/Devitalisation of bone - leave pieces – >

Chronic disease = reactive bone formation @periosteoma = involucrum
+
Brody’s abscess

– >From draining sinus tract formation @skin =
high risk of squamous CC + Sinus tract orifice

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15
Q

Where does avascular necrosis usually occur?

A

Scaphoid
Humeral
Femoral (Most common)
Talus

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16
Q

Explain how an old woman develops avascular necrosis in the femoral head?

A

Insufficiency of Retinacular arteries of the medial circumflex femoral artery

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17
Q

In avascular necrosis what is the necrosis due to?

A

Decreased blood flow – >ischaemic necrosis @bone

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18
Q

What are the causes of avascular necrosis?

A

ASEPTIC

Alcoholism
Sickle-cell disease – dactylitis =
vasoocclusive crisis @both hands and feet

Exo/endogenous corticosteroids – >fat embolus – >occlude microcirculation

Pancreatitis
Trauma – >decreased blood flow
Idiopathic = Legg Calvé Perthe disease
Caisson disease

19
Q

Explain Legg Calvé perthes disease.

A

AAN of ossification centres – epiphysis

@ kids 3–10 years

of femoral head – knee pain/limp

20
Q

Explain Caisson disease.

A

Gas embolus – nitrogen – >

precipitate out of blood – > lodge in bone – > AAN

21
Q

What is the complication of avascular aseptic necrosis

A

AAN under joint – >increased risk of joint damage – >osteoarthritis

AAN under joint – >fracture

22
Q

Explain the difference between a peritrochanteric and subcapsular fracture.

A

PeriTrochanteric fracture = extracapsular = no blood supply to femoral head – > no AAN

Sub capsular fracture = disrupts blood supply –> retinacular art. of medial circumflex fem. artery – > AAN

23
Q

Treatment for avascular aseptic necrosis

A

Joint replacement

Core decompression

Bone graft/BISPHOSPHONATES

24
Q

That’s vertebral osteomyelitis where on the vertebrae are the most common places? What can you form in these places?

A

Lumbar >thoracic >cervical

Abscess

25
Q

Explain how osteomyelitis leads to septic arthritis

A

Osteomyelitis – >infection breaks through cortex – > post discharge into joint = septic arthritis

26
Q

What is a fracture?

A

Breach in structural continuity of bone

27
Q

What are the two main classifications according to its relation to the surrounding tissue

A

Simple + compound

28
Q

What is a simple/closed fracture?

A

The skin/mucous membrane overlying the bone is intact

I.e. does not have contact with the external environment

29
Q

Explain what a compound/open fracture is

A

A fracture that is in contact with the external environment

More likely to be infected

30
Q

What does comminuted mean?

A

> 2 fragments

31
Q

What does complicated fracture mean?

A

Involve viscus/Artery/nerve

32
Q

What is a pathological fracture?

A

Fracture @ abnormal bone i.e. osteoporosis/tumour

33
Q

What is a stress fracture?

A

Repeated application of mind of force – >slowly developing fracture

34
Q

What is a greenstick fracture?

A

Usually at children

One side of bone = fractured – >bent but intact

35
Q

What are the four processes in the bone healing

A

Haematoma
Inflammation
Repair
Remodelling

36
Q

Explain haematoma formation

A

Tear medullary blood vessels – endosteal + periosteal – >

Haemorrhage into marrow space
Haematoma into soft tissue
Periosteal stripping

37
Q

Explain inflammation in bone healing

A

Fibrin clot form = Rich in chemoattractants ->

Neutrophils/macrophages migrate = Clear debris ->

Neovascularisation + fibroblast proliferation = Fibrovascular granulation – >

Mesenchymal precursor cells mature into osteoblasts -> migrate in to granulation tissue

Osteoblast deposit osteoid collagen in haphazard fashion = woven bone

38
Q

Explain repair

A

Outside part of fracture = covered by callus = fibro-cartilage

Inside part of fracture = covered by internal callus = no cartilage

Highly vascular

39
Q

Explain remodelling

A

Osteoclast result she can osteoblast synthesis ->

Remove XS callous +
replace woven with the lamella (compact + organised)

Increased bone strength + vascularity normal

40
Q

What are the principles of fracture management

A

Reduce fracture

Immobilise

Rehabilitate

41
Q

Types of fracture fixation

A

Slings
Cost
Intra/extra medullary devices

External fixation

42
Q

Factors influencing fracture healing?

A

Patient: smoking age nutrition drugs

Tissue: bone type/site/pathology

Treatment: opposition/stability/micromotion

43
Q

What are the early local complications of fractures

A

Vessel damaged nerve damage infection

44
Q

What are the early general complications of fractures

A

Hypovolaemic shock
A RDS
Venus Trumbull embolism
embolism Fat

45
Q

What are the late local complications of fractures

A

Malunion

Delayed union/Non-union

46
Q

What are the late general complications of fractures

A

Poor mobility/income

Msk (10 decks)

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